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Shifting the Battlefield Strategy in the War on Cancer

A greater understanding of what makes each individual cancer unique could shape the way it’s treated in the era of personalized medicine.

The Longest War

With an all-out assault against the war on cancer for nearly 50 years, the greatest myth may be that there is a single enemy with one war to fight. The location of the battle – breast, lung, colon cancer, for example – and available arsenal have historically determined the treatment strategy.

But the more researchers probe, the more they discover – mutations, genes and pathways that create thousands of enemies for hundreds types of cancers.

Reorganizing Our Thoughts on Cancer

Imagine one day, then, that treatment of an individual’s cancer is as unique as the person who has it. This is personalized medicine.

In The Emperor of all Maladies: A Biography of Cancer, author Siddhartha Mukherjee explains, “Every patient’s cancer is unique because every cancer genome is unique … Normal cells are identically normal; malignant cells become unhappily malignant in unique ways.”

Researchers are adapting the way they think about the many “types” of cancer as understanding of specific cancerous mutations, genes and the makeup of cancerous cells increases.

“Instead of breast cancer, lung cancer, bone cancer – the organ of origin – we’re now talking about the molecular classifications; B-RAF mutated cancers, for example. And those molecular classifications can occur in almost any organ, theoretically, although they prefer to be in certain organs,” says Susie Jun, M.D., Ph.D., vice president, development head, oncology and translational medicine, AbbVie StemCentrx.

“Rather than looking for a medicine for all breast cancer patients, we’re looking for a medicine for maybe 10 percent of breast cancer patients that works really, really well.”

A New Way to Test Treatments

This way of thinking about cancer – by the mutation, DNA mishap or other molecular abnormality – that may be evident in the cancerous cell impacts the way medicines are developed and tested.

Traditionally, people join an investigational study of a medicine based on the anatomy of the cancer, like breast or colon cancer, in addition to meeting other criteria to qualify for a particular trial.

As the way of thinking about types of cancer evolves, however, so are the ways researchers study and organize clinical trials. In recent years, this has led to one type of clinical trial called a basket clinical study.

“A basket study generally refers to exploring a given drug in multiple diseases,” says Scott Hirsch, head of portfolio management, AbbVie StemCentrx. “As opposed to testing a therapy in multiple trials, we conduct a single trial that includes patients of various cancer types who express a given target; for example, DLL3. This helps us to efficiently evaluate the safety and efficacy of a targeted treatment.”

The objective is to find more targeted and effective medicines.

“Our goal is to be able to identify the patients who will respond to the drug 100 percent of the time. Rather than looking for a medicine for all breast cancer patients, we’re looking for a medicine for maybe 10 percent of breast cancer patients that works really, really well,” Jun says.

AbbVie is currently conducting a basket trial for an investigational compound in eight different types of cancer with a specific gene expressed on some malignant cells primarily found in neuroendocrine tumors.

Finding the Right Combination

Will developing only targeted medicines be the magic bullet to cure cancer in the future?

Probably not.

“The one thing we know about cancer is that it’s very rarely a single gene or a single target that determines the outcome of the disease,” says Jim O’Brien, M.D., group medical director, oncology early development, AbbVie.

Instead, the goal is finding the right combination of treatments, targeted or systemic.

“The goal for oncology is, ‘can we put together a cocktail aiming at a specific target that induces a cure or at least a very long remission?’” Jun says.

Finding the right combination of treatments for cancer based on each individual could shape the next 50 years of the fight.

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